masterThesis
Contrataciones inteligentes para gestionar el riesgo en salud
Autor
Contreras Campo, Lorena Clareth
Atehortua Mercado, Adriana del Carmen
Institución
Resumen
The present work consists of analyzing and comparing the different contracting modalities used by an EPS of the subsidized regime during the years 2017, 2018 and 2019 for the care of patients with diagnoses of Hypertension and diabetes mellitus, in order to determine what the adequate modality, from the point of view of costs and health results. This is based on the high costs generated from the care of these risk groups, which may be due to the deterioration in the health status of the patient who may not have adhered to specific protection and early detection programs or may be due to the inadequate planning of the technical notes and the contracting modalities used at the time of the negotiation between the insurer and the provider, which is reflected in the high levels of claims reached by the EPS, preventing them from complying with the indicators financial established by the National Superintendency of Health. In search of evidencing if there are significant differences between the average costs of care of patients with pathologies of arterial hypertension and diabetes mellitus, according to the modalities of event contracting and prospective global payment, the Student T test was used, for two independent samples. The choice of this test is due to the evaluation of patients in the HT and DM cohort belonging to two independent groups, those covered by event contracts and those covered by contracts of the Global Prospective Budget modality. The source of information used corresponds to the individual records of service provision (RIPS) reported by the IPS contracted to care for these services during the periods from (1) January 1, 2017 to (31) thirty-one December 2019. The information is initially extracted by health care technology (services provided to treat the disease, for example laboratories, specialized consultations, among others) and is grouped by event (according to the contracting modality). The criteria for grouping the event will be services provided to a patient for a specific date and contract